RESUMEN
BACKGROUND AND OBJECTIVES: Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic disorder, which is a cause of significant morbidity and sudden cardiac death. Extended septal myectomy (ESM) is the therapeutic gold standard to treat left ventricular outflow tract obstruction (LVOTO) in HOCM resulting in long-term symptomatic relief. The aim of the study was to assess the impact of ESM on midterm symptom relief, LVOTO, and survival in patients suffering from HOCM in the Indian population. METHODS: We retrospectively analyzed clinical data of 36 consecutive symptomatic patients with HOCM having symptoms refractory to medical treatment and LVOTO with resting gradient ≥ 50 mmHg and who underwent ESM at our institution from 2010 to 2019. Preoperative and postoperative transthoracic echocardiography was performed to assess left ventricular outflow tract (LVOT) gradient, septal thickness, and assessment of valvar and cardiac function. RESULTS: ESM was performed successfully in all 36 patients. The mean preoperative LVOT gradient was 113.06 ± 36.70 mmHg and decreased to 15.17 ± 7.30 mmHg (p < .0001) in the initial postoperative period. There were two in-hospital deaths (5.6%). There was no further mortality in the subsequent follow-up. The mean septal thickness was 23.89 ± 5.77 mm preoperatively and 13.17 ± 3.48 mm (p < .0001) postoperatively. During a mean follow-up of 2 years, the NYHA functional class improved from 3.50 ± 0.70 (III-IV) to 1.50 ± 0.70 (I) (p < .0001). CONCLUSIONS: ESM results in immediate abolition of mechanical obstruction to LVOT with normalization of left ventricular pressure and eliminates symptoms associated with HOCM.
Asunto(s)
Cardiomiopatía Hipertrófica , Cardiomiopatía Hipertrófica/cirugía , Puente de Arteria Coronaria , Ecocardiografía , Humanos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Left ventricular to left atrial fi stula is a very uncommon finding. Most of the cases are secondary to surgical procedures or paravalvular infectious process. The present case depicted an unusual regurgitation (apart from transmitral MR) through LV-LA fistula causing deterioration of the patient's symptoms.
Asunto(s)
Ecocardiografía/métodos , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/fisiopatología , Adulto , Atrios Cardíacos/diagnóstico por imagen , Atrios Cardíacos/fisiopatología , Atrios Cardíacos/cirugía , Ventrículos Cardíacos/cirugía , Humanos , Masculino , Fístula Vascular/cirugíaRESUMEN
BACKGROUND: Hypopituitarism is characterized by partial or complete deficiency of vital endocrinological hormones such as steroid and thyroid hormones. Generally, normal individual can exhibit 2- to 10-folds rise in serum cortisol levels during stressful period. But patients with panhypopituitarism are more prone to develop metabolic and haemodynamic instability particularly during stressful perioperative period. This can potentially increase significant morbidity and mortality. CASE SUMMARY: A 62-year-old female patient presented with breathlessness on exertion. Her coronary angiography revealed critical triple vessel coronary artery disease, and she was scheduled for coronary artery bypass grafting surgery. She had been diagnosed with Sheehan's syndrome (postpartum hypopituitarism) since 20 years. She was taking steroid and thyroxine regularly. After uneventful off-pump coronary artery bypass grafting surgery, patient had severe haemodynamic compromise with Addisonian crisis in the post-operative phase. Left ventricular dysfunction was refractory to maximal inotropic therapy. Addisonian crisis was treated with higher 'Stress doses' of intravenous hydrocortisone and routine oral thyroxin. DISCUSSION: Acute Addisonian crisis after stressful surgery is a life-threatening complication. Evidence-based approach plays an important role in appropriate biochemical assessments and specific therapeutic decisions regarding hormonal over-replacement or under-replacement in the perioperative period.
RESUMEN
Subcutaneous emphysema is a condition when air gets accumulated into the tissues under the skin and in the soft tissues of the chest wall or neck but can also spread to other parts of the body. It generally causes minimal symptoms and nonlethal; sometimes, it may be severe and life-threatening if deeper tissues of the thoracic outlet and chest are involved. It is essential to know the mechanisms of subcutaneous emphysema after cardiac surgery.
Asunto(s)
Puente de Arteria Coronaria Off-Pump/efectos adversos , Enfisema Subcutáneo/etiología , Femenino , Humanos , Persona de Mediana Edad , Enfisema Subcutáneo/diagnóstico por imagenAsunto(s)
Barorreflejo/fisiología , Bradicardia/fisiopatología , Puente de Arteria Coronaria Off-Pump/efectos adversos , Hemodinámica/fisiología , Complicaciones Intraoperatorias/fisiopatología , Infarto del Miocardio/fisiopatología , Bradicardia/diagnóstico , Bradicardia/etiología , Femenino , Humanos , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/etiología , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/cirugíaAsunto(s)
Ecocardiografía Transesofágica/métodos , Prótesis Valvulares Cardíacas/efectos adversos , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/diagnóstico , Falla de PrótesisRESUMEN
Malposition of venous cannula can cause inadequate venous drainage during cardiopulmonary bypass. It would be good clinical practice to use TEE to check the position of inferior venous cannula to avoid this problem at the earliest.
Asunto(s)
Puente Cardiopulmonar/efectos adversos , Drenaje/efectos adversos , Ecocardiografía Transesofágica/métodos , Cateterismo Venoso Central/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas , Venas Hepáticas/diagnóstico por imagen , Humanos , Masculino , Errores Médicos , Persona de Mediana Edad , Válvula Mitral/cirugía , Vena Cava Inferior/diagnóstico por imagenAsunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Parálisis de los Pliegues Vocales/etiología , Parálisis de los Pliegues Vocales/terapia , Anestesiólogos , Antiinflamatorios/administración & dosificación , Antiinflamatorios/uso terapéutico , Budesonida/administración & dosificación , Budesonida/uso terapéutico , Ablación por Catéter/efectos adversos , Femenino , Humanos , Hipotermia Inducida/efectos adversos , Enfermedad Iatrogénica , Intubación Intratraqueal/efectos adversos , Persona de Mediana Edad , Nebulizadores y Vaporizadores , Tempo Operativo , Vapor , CirujanosAsunto(s)
Taponamiento Cardíaco/etiología , Inclinación de Cabeza , Posicionamiento del Paciente/efectos adversos , Complicaciones Posoperatorias/etiología , Taponamiento Cardíaco/diagnóstico , Taponamiento Cardíaco/terapia , Tratamiento Conservador/métodos , Ecocardiografía Transesofágica , Femenino , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/terapiaAsunto(s)
Tabique Interatrial/cirugía , Defectos del Tabique Interatrial/cirugía , Ventrículos Cardíacos/diagnóstico por imagen , Dispositivo Oclusor Septal/efectos adversos , Adulto , Tabique Interatrial/diagnóstico por imagen , Cateterismo Cardíaco , Ecocardiografía Transesofágica , Femenino , Estudios de Seguimiento , Defectos del Tabique Interatrial/diagnóstico , Humanos , Falla de PrótesisAsunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Parálisis de los Pliegues Vocales/etiología , Parálisis de los Pliegues Vocales/terapia , Ronquera/etiología , Ronquera/prevención & control , Ronquera/terapia , Humanos , Complicaciones Posoperatorias/prevención & control , Parálisis de los Pliegues Vocales/prevención & controlRESUMEN
Inverted left atrial tissue is mostly identified when the heart is empty while coming off bypass. During echocardiography a new, echodense mobile mass in the left atrium without attachment is visualized. Such a picture can easily produce not only confusion in the diagnosis but also mitral valve obstruction, hemodynamic instability, and a possibility of appendage necrosis. Inability to identify such inverted tissue can lead to unwanted interventions with additional cardiopulmonary bypass time.
Asunto(s)
Apéndice Atrial/anomalías , Procedimientos Quirúrgicos Cardíacos/métodos , Cardiopatías Congénitas/diagnóstico , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Adulto , Apéndice Atrial/diagnóstico por imagen , Diagnóstico Diferencial , Ecocardiografía Transesofágica , Femenino , Atrios Cardíacos , Cardiopatías Congénitas/complicaciones , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/cirugía , Humanos , Válvula Mitral/diagnóstico por imagen , Mixoma/complicaciones , Mixoma/cirugía , Periodo PosoperatorioRESUMEN
Cold agglutinin disease is an uncommon disease with potential to cause hemolysis and thrombosis during hypothermic cardiac surgery. Antiphospholipid syndrome is also rare disease with hypercoagulation tendacy. Perioperative management of both these diseases is challenging. We present successful perioperative management of high risk Bentall surgery in patient with both these dreadful diseases.
Asunto(s)
Anemia Hemolítica Autoinmune/inmunología , Anticuerpos Antifosfolípidos , Hemólisis , Humanos , Hipotermia , TrombosisAsunto(s)
Ecocardiografía Transesofágica/métodos , Atrios Cardíacos/diagnóstico por imagen , Defectos del Tabique Interatrial/diagnóstico , Tabiques Cardíacos/diagnóstico por imagen , Adulto , Procedimientos Quirúrgicos Cardíacos/métodos , Atrios Cardíacos/cirugía , Defectos del Tabique Interatrial/cirugía , Tabiques Cardíacos/cirugía , Humanos , Masculino , Dispositivo Oclusor SeptalAsunto(s)
Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas , Adulto , Aorta , Ecocardiografía Transesofágica , Falla de Equipo , Femenino , HumanosRESUMEN
Patient with embolic episode should always be evaluated for cardiac mass. Mass in left ventricular can be a myxoma or thrombus even in a normal functioning heart. In either case, mobile mass with embolic potential should be surgically resected.
Asunto(s)
Trombosis Coronaria/diagnóstico , Neoplasias Cardíacas/diagnóstico , Mixoma/diagnóstico , Adulto , Procedimientos Quirúrgicos Cardíacos , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/cirugía , Diagnóstico Diferencial , Disartria/etiología , Ecocardiografía Transesofágica , Embolia/diagnóstico , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Ventrículos Cardíacos , Humanos , Masculino , Infarto del Miocardio/diagnóstico , Mixoma/diagnóstico por imagen , Mixoma/cirugía , Paresia/etiologíaRESUMEN
A 58-year-old male was admitted with history of shortness of breath and recurrent fever since two months. He had undergone permanent pacemaker implantation six years back for complete heart block. The patient was persistently having thrombocytopenia. Echocardiographic examination revealed mass (size 4.28 cm(2)) attached to pacemaker lead in right atrium. The patient was scheduled for open-heart surgery for removal of right atrial mass. During surgery, pacemaker leads and pulse generator were also removed along with mass considering the possible source of infection.